Identification of lead in Asian cosmetics—A test for use by health visitors

Advice given to Asian mothers by the Department of Trade and Industry on testing forlead in traditional cosmetics is proving misleading and is giving rise to concern. No satisfactory test for lead which can be carried out by the mothers currently exists. However, it is recommended that the “water flotation test” is modified by using liquid paraffin and redefining the criteria applied to the results. It is further suggested that testing for lead in these cosmetic materials is performed more definitively by community health visitors who, with minimal instruction, can perform the simple analyses described in detail herein.In conclusion it is recommended that the emphasis should be more firmly based on education of the Asian mother away from use of surma instead of devising methods for testing for lead which may be misleading and, in the long term, are impractical.     

An audit of antibiotic prescribing in generalpractice using sore throats as a tracer for quality control

A prospective survey was made of antibiotics prescribing behaviour in 152 consecutive cases of “primary sore throat” (primary sore throat is an unsolicited presented complaint; sore throats on direct questioning are excluded in this study), identified from 1116 consultations during a 4-month period in general practice. Twenty-nine of 152 cases (19%) were throat-swab-positive. All positive swabs grew β-haemolytic streptococci sensitive to penicillin. Eighteen cases of haemolytic streptococci sore throat were diagnosed correctly on clinical grounds and given antibiotics appropriately (sensitivity=56·3%), whilst 61 cases (40%) were given antibiotics inappropriately (specificity 50·4%).The study was further divided into pre-audit periods in order to observe the effect of “audit” on clinical behaviour. There was a significant reduction in inappropriate antibiotic use in the post-auditing period. (False positive fell from 49% to 30%, significance of difference P=0·01–0·05). This fall was achieved without significant change in sensitivity.     

Clinical and Translational Science Awards and Community Engagement: Now Is the Time to Mainstream Prevention into the Nation's Health Research Agenda

Although much attention is devoted to the slow process of cutting-edge “bench science” finding its way to clinical translation, less attention is paid to the fact that basic prevention messages, tests, and interventions never find their way into communities. The NIH Clinical & Translational Science Awards program seeks to address a broad mission of improving health, including both speeding up the incorporation of basic science discoveries throughout the clinical research pipeline and incorporating concerns of communities and practices into research agendas. The preventive medicine community now has an important opportunity to marry their mission of promoting and expanding prevention in communities to the nation's medical research agenda. This article suggests opportunities for collaboration.     

The use of microcomputers by community physicians

A microcomputer can be a very useful everyday tool for a community physician. Two commercially available “packages” are discussed. They require no previous programming skills, and although designed for business use are particularly appropriate to the tasks of community medicine.     

Prospects for improving health through reducing risk factors

Intervention against both bodily risk factors such as hypertension, high serum cholesterol, cervical dysplasia, and trisomy 21; and behavioral risk factors such as cigarette smoking, too little exercise, and excessive alcohol consumption, offers improving prospects for reducing major current causes of death. The MRFIT program and other trials of intervention in North Karelia, Finland, and in northern California, are aimed at delineating how effective this strategy may be. Already it is clear that the risk factor intervention strategy may incorporate one or both of two tactics: the “medical model,” i.e., selecting individuals for intervention efforts on the basis of medical examinations; or the “community model,” i.e., directing efforts for risk factor reduction at a total community. This new approach to prevention represents a shift away from the clinical entities as the focus of medicine toward the identification and reduction of the factors that lead to clinical disease. The aim is not just to avoid clinical disease but to maintain health in the sense of physiologic function, anatomic regularity, chemical balance, genetic integrity, immunologic status, and healthful behavior.     

A survey of the applications of computersin the community health services-community health systems

In November 1984 a questionnaire survey was circulated to discover the current stateof the art with regard to computer applications in the community health services across the U.K. This survey was combined with a more traditional literature search for relevant information, making much use of computerized on-line techniques for access to bibliographic databases such as Medline. This paper summarizes many of the applications discovered wich make up the “state-of-the-art” such as the many recall systems and nurse workload analysis packages reported, and also presents a selection from the numerous “results” obtained following computer analysis of the responses collected.It is interesting to note the extremely widespread use of microcomputers withincommunity health departments, and the enormously varied applications to which they are put. There is a whole proliferation of computer applications in the community, but only a small number of authorities when considering the country as a whole make any where near full use of the new technology. This is the only attempt that has been made as far as I am aware to collect together national data, regarding community health computer applications and make available a register of the applications reported on.     

Infant mortality in Hong Kong

Official estimates of infant mortality in Hong Kong show a remarkable decrease over the last 30 years. Between 1950 and 1980 infant mortality rates fell from 99·6 to 11·8/1000 live births - transition from a typical “Third World” rate to one better than that for many European countries, including the U.K.^1,2 (It should be noted that the figures exclude Hong Kong's illegal immigrant population, who are unable to use any Government service and for whom no figures are available.)The improvement seen amongst the legal population may partly be explained by the increasing wealth and westernization of the Colony, and the concomitant lowering of the birth rate to near-Western levels (Table 1). The average wage in Hong Kong, however, at about £25 per week, is well below European levels, while per capita health care expenditure and the quality of housing is low by Western standards. This study bears out the accuracy of the figures and their true representation of infant mortality in the general population.     

Sanatorium admissions in a boys'' boarding school

A survey of sanatorium admissions in a boys' boarding school covering 11 “school years” from 1971 to 1982 is presented. Nine-nundred-and-seventy boys accounted for 1500 admissions. The average length of admission was 3·8 days. Classification of the three main groups-infections (57%), injuries (32%) and miscellaneous (11%) are given. The factors causing boys to be illness- and injury-prone are discussed. The value of a school sanatorium is stressed. The views of the boy patients are given.     

Sí, doctora

Experience with seeing Latino patients at a community health center has taught a family physician that the patient’s response, “Sí, doctora [Yes, doctor]“ can have multiple meanings. Patients might say “yes” during consultations to avoid conflict or to defer to the more powerful doctor. The clinician’s understanding had to move to deeper levels when a visiting Ecuadorian friend learning English used “yes” multiple times in conversation, but not as an indicator of agreement or even comprehension. The family doctor realized that she could not assume what the patient implies by this simple expression. The apparent agreement of “yes” requires more. When a patient says, “Sí, doctora,” the doctor must probe with more questions and listen hard to the answers.     

Integrated nutritional, hormonal, and metabolic effects of recombinant human growth hormone (rhGH) supplementation in trauma patients

An anabolic stimulus is needed in addition to conventional nutritional support in the catabolic “flow” phase of severe trauma. One promising therapy appears to be rhGH infusion which has direct as well as hormonal mediated substrate effects. We investigated on a whole-body level, the basic metabolic effects of trauma within 48–60 h after injury in 20 severely injured (injury severity score [ISS] = 31 ± 2), highly catabolic (N LOSS = 19 ± 2 g/d), hypermetabolic (resting energy expenditure [REE] = 141 ± 5% basal energy expenditure [BEE]), adult (age 46 ± 5 y) multiple-trauma victims, before starting nutrition therapy and its modification after 1 wk of rhGH supplementation with TPN (1.1 × REE calories, 250 mg N·kg⁻¹·d⁻¹). Group H (n = 10) randomly received at 8:00 a.m. on a daily basis rhGH (0.15 mg·kg⁻¹·d⁻¹) and Group C (n = 10) received the vehicle of infusion. Protein metabolism (turnover, synthesis and breakdown rates, and N balance); glucose kinetics (production, oxidation, and recycling); lipid metabolism, (lipolysis and fat oxidation rates), daily metabolic and fuel substrate oxidation rate (indirect calorimetry); and plasma levels of hormones, substrates, and amino acids were quantified. In group H compared to group C: N balance is less negative (−41 ± 18 vs −121 ± 19 mg N·kg⁻¹·d⁻¹, P = 0.001); whole body protein synthesis rate is 28 ± 2% (P = 0.05) higher; protein synthesis efficiency is higher (62 ± 2% vs 48 ± 3%, P = 0.010); plasma glucose level is significantly elevated (256 ± 25 vs 202 ± 17 mg/dL, P = 0.05) without affecting hepatic glucose output (1.51 ± 0.20 vs 1.56 ± 0.6 mg N·kg⁻¹·min⁻¹), glucose oxidation and recycling rates; significantly enhanced rate of lipolysis (P = 0.006) and free fatty acid reesterification (P = 0.05); significantly elevated plasma levels of anabolic GH, IGF-1, IGFBP-3, and insulin; trauma induced counter-regulatory hormone (cortisol, glucagon, catecholamines) levels are not altered; trauma induced hypoaminoacidemia is normalized (P < 0.05) and 3-methylhistidine excretion is significantly low (P < 0.001). Improved plasma IGF-1 levels in Group H compared with Group C account for protein anabolic effects of adjuvant rhGH and may be helpful in promoting tissue repair and early recovery. Skeletal muscle protein is spared by rhGH resulting in the stimulation of visceral protein breakdown. The hyperglycemic, hyperinsulinemia observed during rhGH supplementation may be due to defective nonoxidative glucose disposal, as well as inhibition of glucose transport activity into tissue cells. The simultaneous operation of increased lipolytic and reesterification processes may allow the adipocyte to respond rapidly to changes in peripheral metabolic fuel requirements during injury. This integral approach helps us to better understand the mechanism of the metabolic effects of rhGH.     

Mass Media, Secular Trends, and the Future of Cardiovascular Disease Health Promotion: An Interpretive Analysis

Mass media roles in promoting cardiovascular health in the context of lessons learned from major U.S. community studies, changing media technology, and emergent models of media-community partnerships are discussed. Three principal issues are explored: (1) implications of the current expansion, convergence, and harmonization of mass media technology;(2) recent trends in media coverage of heart disease and population practices; and (3) implications for the future relationship between the media and public health in cardiovascular health promotion. It is concluded that classic campaign models focusing on individual-level change have evolved to recognize environmental-level influences on behavior. Emergent public health campaign models have moved toward “agenda-building,” in which the focus is on a more unified approach to influencing public and community agendas for social, behavioral, and policy change. Recent developments among the commercial mass media may offer new opportunities for public health partnerships to promote cardiovascular health.     

An Academic Clinician’s Perspective on the Care of the Geriatric Patient

This paper discusses the role that the personal history plays in a patient’s perception of his or her own illness in the light of the patient’s own personal history. It demonstrates the regrettable modern tendency to regards the patient as the “bearer of a disease” rather than as a human being with personal values and experiences into which their current illness needs to be integrated. I illustrate my point by an exchange between a student and an “attending” and the “attending” and the patient. It represents only one out of unfortunately many such instances in which the pressures of “managed care” and “efficiency” have made truly knowing the patient as an individual with life experiences and personal values much more difficult.     

Impacts of sensory attributes and emotional responses on the hedonic ratings of odors in dairy products

Consumers often decide to purchase certain items as a result of prompt emotional responses evoked by the products; therefore, it is important to investigate the emotional responses stimulated by food samples, as well as the sensory attributes of the products. The aim of this study was to examine influences of sensory attribute and emotional response on olfactory hedonic ratings of dairy products. Additionally, we compared this effect between women and men subjects. Sensory attributes of six natural odors produced by commercial dairy products were evaluated by 9 trained panelists. In addition, 100 untrained panelists (50 women and 50 men) rated the emotional response stimulated by the 6 odors using 25 paired semantic differential scales and the hedonicity using a 9 cm line scale, respectively. Untrained panelists more liked “sweet aromatics,” “sour aromatics,” “fermented aromatics,” and “rich aromatics” over the other sensory attributes of dairy products. The olfactory hedonic ratings were increased when the odor was more characterized as “fragrant,” “attractive,” “comfortable,” “familiar,” “faint,” “natural,” or “modern.” Specific sensory attributes were found to be related to specific adjective pairs representing the emotional response. Moreover, the ratings of adjective pairs representing emotional response of odors and their influences on hedonic ratings differed significantly between sexes. In conclusion, our findings suggest that the emotional responses as well as the sensory attributes affect the hedonic ratings of odors in dairy products.     

Community Medicine in India — Which Way Forward?

Today, the Community Medicine professionals in India feel both “confused” and “threatened” by the mushrooming of schools of public health and departments of family medicine. The phenomenon of identity crisis and low-self esteem is not a recent one, nor is it restricted to India. The disciplines of community medicine and public health have evolved differently and despite some overlaps have differences especially in the need for clinical training. The core of the issue is that while the community medicine fraternity is keen to retain its clinical tag, what differentiates it from clinicians is the use of public health approach. I believe the strength of community medicine is that it bridges the gap between traditional fields of public health and clinical medicine and brings community perspective into health. The perceived threat from non-medical persons led public health is largely a result of us undervaluing our strength and our inability to foster partnership on equal footing with non-clinicians. While departments of community medicine have a fully functional rural or urban field practice area used for training at primary level care, these can serve as an excellent platform for training in secondary level care required for family medicine. National needs dictate that all three disciplines are required for improvement of population health, whether these are housed together or separately can be left to individual institutions to decide as long as they enable collaborations between them. We need to strengthen community medicine and market it appropriately to ministries of health.     

Dissecting Obesogenic Environments: The Development and Application of a Framework for Identifying and Prioritizing Environmental Interventions for Obesity

Background. The “obesogenicity” of modern environments is fueling the obesity pandemic. We describe a framework, known as ANGELO (analysis grid for environments linked to obesity), which is a conceptual model for understanding the obesogenicity of environments and a practical tool for prioritizing environmental elements for research and intervention.Methods: Development of the ANGELO framework. The basic framework is a 2 × 4 grid which dissects the environment into environmental size (micro and macro) by type: physical (what is available), economic (what are the costs), political (what are the “rules”), and sociocultural (what are the attitudes and beliefs). Within this grid, the elements which influence food intake and physical activity are characterized as obe sogenic or “leptogenic” (promoting leanness).Results: Application of the ANGELO framework. The ANGELO framework has been piloted at the population level (island communities) to prioritize the settings/sectors for intervention and at the setting level (fast food outlets) to prioritize research needs and interventions. Environmental elements were prioritized by rating their validity (evidence of impact), relevance (to the local context), and potential changeability.Conclusions. The ANGELO framework appears to be a flexible and robust instrument for the needs analysis and problem identification stages of reducing the obe sogenicity of modern environments.     

The “U” technique: A new method for Norplant implants removal

The standard technique for Norplant implants removal was compared with a new technique called the “U” technique, which employs the use of a modified no-scalpel vas deferens holding forceps to grasp and remove the capsules. Seventy-six women requesting Norplant implants removal were randomly assigned to Group 1 (standard removal technique) or Group 2 (“U” removal technique). Variables measured included: (a) time required for complete removal, (b) number of capsules not broken or damaged during removal, and (c) number of incisions required for removal of all six capsules. In clients with visible or palpable capsules, the standard removal technique required significantly more time to remove all six capsules, on average, than the “U” technique (19 versus 7 minutes, p < 0.001); also more capsules were damaged during removal (5.6 undamaged versus 6.0,p < 0.01). In addition, with the standard technique, five clients required two incisions for removal of all six capsules while none of the clients required more than one incision with the “U” technique. Our conclusion is that the “U” technique is a quicker and easier method of removing Norplant capsules than the standard technique.     

Medicalisation of food advertising. Nutrition and health claims in magazine food advertisements 1990–2008

Food advertising increasingly portrays food as a type of medicine. A content analysis of magazine food advertisements in 1990 through 2008 shows that this was manifested with time more in the (a) nutrition claims and (b) health claims made in food advertisements, as well as the (c) food groups and (d) media genres to which nutrition and health claims in food advertising pertained. This so-called “medicalisation” of food advertising may promote images of the body and mind as malfunctioning unless remedied by the use of – advertised – products.     

Infinitesimal risk as public health crisis: News media coverage of a doctor-patient HIV contact tracing investigation

Among the most prominent health or medical stories covered in 1994 by the Australian news media was that concerning an HIV positive hospital obstetrician and the attempt by the New South Wales Health Department to trace and test 149 women on whom he had operated. All press and television coverage of the issue was reviewed. The surface news narrative of the search for missing, “innocent” mothers potentially infected with a deadly and infectious illness is shown to serve as a “hard news” pretext enabling a wider major discourse to operate about a health system accused as being captive to gay and civil libertarian politics, allowing “guilty” doctors at high risk of HIV to endanger “innocent” patients. Expert consensus held that the women were at “infinitesimal risk” of acquiring HIV. However, media accounts of the investigation all but belied this, illustrating that the news media's framing of risk has more to do with its reproduction of moral outrage components than with “scientific” notions of calculable risk.     

Deltamethrin Multifactorial Activity toward Carp Larva Mobility Related to Calcium, Humic Acids, and pH

The toxicity of pyrethroid insecticide deltamethrin was assesssed by the “escaping capability” of carp larvae out of a trap. Mobility was tested after 1, 4, and 12 hr exposure to eight deltamethrin concentrations in standard water and after 24 hr exposure to seven deltamethrin concentrations in 18 media derived from the combinations of pH levels of 6.9, 7.8, 9.0, calcium concentrations of 2 · 10⁻⁴and 2 · 10⁻²M,and humic acid concentrations on 0, 5 and 100 mg/liter. In standard water, a 1-hr exposure at 4 μg/liter deltamethrin increased the mobility, while a 4-hr 32 μg/liter exposure decreased it. After 24 hr without deltamethrin, mobility was reduced at pH 6.9 and 7.8 and 2 · 10⁻⁴Mcalcium. It was also reduced in 100 mg/liter humic acids, especially when the former pH and calcium conditions were used. Humic acid effects could partly result from a calcium concentration reduction in water, and darkness due to humic acid coloration could play a minor role. Increasing humic acid concentration, calcium concentration, and pH reduced deltamethrin activity. In 0 or 5 mg/liter humic acids the No Observed Effect Concentration was 1 μg/liter, and in 100 mg/liter humic acid it was 2 μg/liter. Compared to previous results on deltamethrin-induced lethality, the escape test appeared less reproducible, but was 2 or 4 times more sensitive.